I have had Type 1.5 Diabetes for 27 years on an Insulin Pump. I have several comps including anemia, chf (dyastolic), cad, ckd and severe neuropathy. I also have GERD and a history of colon polyps. I have a colonoscopy about every 3 years and a gastroscopy every 2 years. 2 years ago I went to a Hematologist at the Beth Israel Deaconess Medical Center in Boston. After routine blood work he told me that my ferritin level was 18 and that I was bleeding somewhere. He advised me to go to my Gastroenterologist. At that time, as I had recently had a Gastroscopy and Colonoscopy, the Gastroenterologist suggested a camera swallow. That was negative. My pcp treated me with Iron and at her lab, I feel not a very good lab, my Ferrtin was normal. A few days ago I returned to the Hematologist becuase I have had frequent spontaneous bloody noses. He again repeated blood work. MyHgb was 12 and my Hct was 34.6. My rbc was 4.06. My ferritin was very low at 15 this time. There range is 30-400. My regular iron was 64 range of 45-160. My calTIBC 391 260-470 range. My TRF was 301 200-360 range. He said that I am either bleeding somewhere or that I am not absorbing Iron. Through his observation, as I am pretty hefty, he said I looked like I was absorbing well. He suggested that I call my PCP and/or my Gastroenterologist and have a Colonsocopy and also be tested for Celliac. A while back I was tested for Celliac and it was normal at that time. I called my PCP and she insulted me and said I was playing Doctors like it was some kind of sport. One other FYI for about 2-3 months between December and February, I was having major episodes of Syncopee and the diagnosis leaned toward vasal vagal and autonomic dysfunction. I have had a confirmed diagnosis of both Autonomic and Cardiac Autonomic Neuropathy for about 4-5 years now. My question is what could be causing this low Ferritin and should I be concerned about it? I must admit I am a bit anxious and concerned.
Indeed, a low ferritin can be indicative of iron deficiency anemia. And the most common cause of this would be a GI bleed.
That said, you had a comprehensive workup, including the endoscopies and the camera endoscopy.
Sometimes, bleeds in the small bowel can be difficult to detect, and more specialized tests like a bleeding scan or push enteroscopy should be considered.
Serially monitoring the CBC can be done to ensure the hemoglobin level stays stable, and I agree with the iron supplementation.
Discussing these tests with another gastroenterology opinion should be considered, and you may also want to consider a second hematology opinion.
I would also evaluate the thyroid, as low levels here can also reduce the ferritin level.
If the diagnosis continues to be non-revealing, then simply serial blood tests to ensure stability of the values can be considered.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin Pho, M.D.
Copyright 1994-2017MedHelp International.All rights reserved. MedHelp is a division of Aptus Health.
The Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease; or a recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action. Med Help International, Inc. is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. Never disregard the medical advice of your physician or health professional, or delay in seeking such advice, because of something you read on this Site. We offer this Site AS IS and without any warranties. By using this Site you agree to the following Terms and Conditions. If you think you may have a medical emergency, call your physician or 911 immediately.